风险管理和评估技术在职业病监管中的应用

Exploration of risk management and risk assessment techniques in surveillance and management of occupational diseases

目的尝试将风险管理和风险评估技术应用于职业病监测和管理,探索适宜的风险评估方法和指标体系。方法收集某市职业病监测数据,参考《风险管理风险评估技术》(GB/T 27921-2011)、《突发公共卫生事件风险评估工作指南(2014版》对职业病风险进行评估,风险评估采取专家会商法和风险矩阵法,并根据风险评估结果提出风险管理建议。结果初步构建职业病风险发生可能性和后果的指标体系。可能性指标体系主要基于职业病人发现情况、职业病危害接触人数、职业卫生监管覆盖和危害因素检测结果、职业健康体检覆盖和疑似职业病检出等4方面因素;后果指标体系主要基于危害因素固有健康损害特征、引发群体事件可能性、职业病人权益保障、对经济社会影响等4方面因素。通过风险评估,识别出需优先关注和重点管理的职业病,并提出分级风险管理建议。结论风险管理和风险评估技术应用于职业病监测和管理,有很好的适用性和效果。建议尽快建立我国职业病监测风险评估制度。

Objective To apply risk management-risk assessment techniques to the surveillance and management of occupational diseases and explore the method and indicator system for risk assessment. Methods The data reported from a city＇s occupational disease surveillance system were collected and assessed according to Risk Management-Risk Assessment Techniques（ GB/T 27921-2011）,Risk Assessment Guidelines of Public Health Emergency（ 2014 Edition）. Risk assessment was conducted by combining experts meetings with risk matrix,and risk management recommendations were put forward according to the risk assessment results. Results The two indicator systems for probability and severity of occupational diseases risk were established preliminarily. The indicator system for probability was established based on occupational disease incidence,number of workers exposed to occupational hazard,coverage of occupational health supervision and occupational physical examination,while the indicator system for severity based on extent of health damages,possibility of sparking group emergent events,rights and interests security for occupational patients,and impacts on society and economy. The risk levels of occupational diseases were determined respectively via risk assessment,and hierarchical risk management strategies were proposed. Conclusions Risk management and risk assessment techniques can be applied to occupational disease surveillance and management due to its applicability and effectiveness. It suggests that risk assessment system of occupational diseases surveillance should be early established.